NEW YORK (Reuters Health)—Elevated lipid levels are associated with an increased revision-surgery rate after arthroscopic rotator cuff repair, while statin use appears to mitigate that increase, according to a database review.
“[Although] it supported our hypothesis, we found it interesting to finally demonstrate a link between hyperlipidemia and rotator cuff-repair failure resulting in revision surgery clinically,” Dr. Brian C. Werner from the University of Virginia, in Charlottesville, tells Reuters Health by email. “Prior studies have demonstrated a connection, but only in laboratory animals.”
Animal studies have also shown that hyperlipidemia is associated with poor tendon-bone healing after rotator-cuff repair, but these findings have not yet been substantiated in human studies.
For their study, online Aug. 8 in The American Journal of Sports Medicine, Dr. Werner and colleagues used information from the PearlDiver insurance-based database of patient records. Individuals with moderate or high total cholesterol or LDL cholesterol levels had revision-surgery rates 20% to 79% higher than individuals with normal levels, although actual revision rates for all groups were generally low (3.11–5.14%).1
Patients with elevated cholesterol or LDL levels who had perioperative prescriptions for a statin had revision-surgery rates similar to those of patients with normal/low cholesterol or LDL levels.
The number needed to treat with statins to reduce the number of revisions by one was high, ranging from 54–408 for total cholesterol and from 53–387 for LDL.
Triglyceride levels did not appear to be associated with the rate of revision rotator cuff surgery.
“It is hard to make a firm recommendation based on a retrospective database review, such as this study, but this adds to a growing body of basic science and clinical literature that demonstrates a strong association between hyperlipidemia, poor tendon-to-bone healing, and need for revision surgery after rotator cuff repair,” Dr. Werner says. “There is also existing evidence that hyperlipidemia is associated with the development of rotator-cuff disease in the first place.”
“Healing after rotator-cuff repair is multifactorial and includes patient, surgeon, biomechanical and biologic variables,” he says. “Hyperlipidemia should definitely be considered a modifiable risk factor for failure, although it is important to note that failure rates were low in all cohorts.”
“Future prospective studies are necessary to determine if improved lipid control perioperatively results in improved healing rates after rotator-cuff repair,” Dr. Werner says.
- Cancienne JM, Brockmeier SF, Rodeo SA, et al. Perioperative serum lipid status and statin use affect the revision surgery rate after arthroscopic rotator cuff repair. Am J Sports Med. 2017 Aug 1:363546517717686. doi: 10.1177/0363546517717686. [Epub ahead of print]